Home nursing care and Rehabilitation

Introduction:

The World Health Organisation (WHO) estimates that 10 percent of human beings (about 600 million people) are disabled in one way or another.

Many disabled are looked after but few have had advice on how to take charge of their own lives, to develop their abilities and live as respected members of their communities.

Families always hope for a cure if this is not possible, the doctor says there is no treatment possible, they despair and many think their relative will be a burden to the family as he will need assistance for the rest of his life. The community does not see disabled people as a priority and the way to help disabled is to give them things.

Many of them (maybe half of that ten percent) are however not perceived as disabled by their communities. They make use of existing services such as health clinics, schools, churches and mosques and are functioning within their local communities. They might however not be functioning to their maximum potential as the services could be better designed. Many children with mild learning difficulties for example attend school but do not learn to read or write due to the large classess and the lack of special needs services in most schools in Africa.

The development of rehabilitation services for people with disabilities is therefor a great need.

Rehabilitation:

The objective of rehabilitation is to enable people with disabilities to be active participants in community life.

To enable PWD:
- To take care of themselves and to be as personally interdependent as
possible (the individual factor);

- To have social relationships, and to take part in the activities of the
community (the social factor).

- To contribute towards their own and their families' livelihood (the
economic factor).

The concept rehabilitation in our church member

Rehabilitation is a rapidly growing approach of providing appropriate health care to disabled people elderly and bed ridden

Home nursing and Rehabilitation is a strategy within community development for the rehabilitation and equalisation of opportunities and social integration of all people with disabilities.

Traditionally rehabilitation had a very medical, clinical orientation, mainly focusing on the impairment and the individual.

In literature it is often mentioned that the individual, through use of activities, is able to change his environment. Little attention and importance was given however to

The attitude of families and communities towards people with disabilities and how this can jeopardise a person’s ability to perform, as he would like.

The community and the environment create demands for particular behaviour from the individual. Rehabilitation should therefore be more socio-cultural oriented and take into account the local culture, ethnicity, economic status, political environment, religion, gender and other such variables.

It is now recognised that for successful rehabilitation you can not just focus on the individual person with a disability; you need to involve the family and community into the rehabilitation process

Through the community based approach you are now able to address all different components of rehabilitation, which will contribute to the integration and participation of the disabled person in community life.

The home rehabilitation concept is flexible. There are many different ways of doing home rehabilitation, some more realistic and effective than others, depending on the nature of the community itself

The common themes of rehabilitation programmes are:

- The training of parish workers, who provide
services to disabled people at their homes and within their communities.

- The use of locally available human and material resources.

- The use of a certain organisational structure.

This service has been promoted as the most suitable and appropriate method of rehabilitation for developing countries. It is supposed to enhance the coverage of rehabilitation services within reasonable costs.

The following is a simplified structure/function chart of the home nursing care process:

PARISH WORKER WOMEN GROUP,AND VOLUTEERS

SPECIALIST SUPERVISOR.

NURSE midwife,occupational therapist

Survey/detection

Training assessment

referrals

stimulation/developmen

training

Monitoring Advice advice/information

Advice

Evaluation

DISABLED PEOPLE,ELDERLY;BED RIDDEN AND THEIR FAMILY MEMBERS

Environment:

As an individual you do not live in isolation, you are a member of a family and a community; situated in a particular environment. The environment is dynamic and can have an enabling or constraining effect on a person’s ability.

Environment

Community

Family

Individual

Individual client:

Working as a therapist or rehabilitation worker in the community you are able to offer a comprehensive individual treatment plan.

You are able to do a better assessment taking into account, the person’s background, culture and community.

Objectives can be set together not just with the individual but also with the people he relies on in his live and making use of the local available resources.

The physical environment is right their and the demands are therefor more easily assessed, adapted and used within treatment.

Therapy treatment becomes than more appropriate and is more sustainable even after the therapy is finished.

The local Parish worker (PW) visits several disabled people a day, at there own homes.

They are particularly looking for people with problems in carrying out activities of daily life. The PWD’s assess the needs in the fields of selfcare, work, and leisure.

For example:

- A disabled mother with a physical impairment may need help in learning the special skills to be able to perform her role as parent and housekeeper;

- Another person will need to perform regular exercises to maintain strength in his legs which enables him to continue walking;

- A disabled father wants to learn making carpets, so he is able to earn a living for his family by selling them at the local market.

The PW will then, with the expert back up of a trained therapist, develop individual training programmes with the client, all of which aim at reducing or overcoming the disability or disability-related problem.

The PW will herself receive regular visits from specialists and supervisors, who provide diagnoses, help to formulate suitable action plans, monitor progress, and provide technical, material and moral support to the rehabilitation worker.

Based in the community you are able to care for elementary needs and to raise the quality of life.

Family:

Family and the extended family play an important role in the African societies. As there is a mutual dependency it is very important to involve influential family members within the rehabilitation process. In the European context, living independently is important as many people live by themselves. In Tanzania it is an important concept because it is usually expected that if I help you, you help me. In other words for the disabled person to get assistance, he should be able to give something-useful back to the family.

Another strong belief is that if you have become physically disabled you are not able to work and will therefor be dependent and a burden on the family. It is also generally accepted that disabled people should be given handouts and can ask for them.

For us these are two important cultural aspects to take into consideration, when working with the disabled and his family.

At the level of family and relatives we are able:

- To give education and advice on disability and rehabilitation,

- To give moral support,

- To encourage them to give support and motivation to the disabled family member.

- To train them to give rehabilitation services to the disabled person,

- To assist in adapting the (physical) environment,

In general in the community the advice is more likely to be appropriate to the local cultural, social, economic, ethnic and political environment.

This way the family becomes an active participant in the rehabilitation process.

Community:

Based in the community you are able to develop a better understanding of the socio-cultural aspects.

Here the main objective is:

- To stimulate equal participation of your disabled clients in community activities.

You can try to achieve this through:

- Co-operation with health centres/ dispensaries

v To improve early detection by educating MCH clinic staff

v To create awareness of health needs of people with disabilities (epilepsy is a very big problem in most local communities)

- Co-operation with educational services

v To promote education of children with disabilities

v To advice local authorities on the educational needs of children with disabilities

v To facilitate integration into local primary schools or if needed facilitate the development of special classes

v To give education and support to teachers

- Vocational activities

v To facilitate the integration into local vocational training opportunities

v To stimulate relatives to support their young relative with a disability to start an income generating activity

v To stimulate the start of support groups

- Social/ Leisure activities

To facilitate the participation in:

v Religious activities

v Weddings/funerals

v Village meetings

v Hanging around

- To create awareness in the Community

v Through people with disabilities being active themselves

v Through community meetings

v Religious meetings

v At any large community gathering

Ø To speak about their abilities and needs and how the Community can help.

Ø To work with local community development workers

- To work with Primary Health Care Teams on Prevention of disabilities.

v Education of Primary Health Care workers

v Detection and referral (esp. of operable/curative conditions)

v Advice to families on vaccinations, nutrition and hygiene.

Some examples are:

- Trying to increase ‘coverage’ with limited resources, which leads to poor quality.

- Moving the rehabilitation to the families;

¨ Are families often poor and working full-time for survival and other basic needs, willing to take up this burden?

¨ The disability of one family member is not always seen as that problematic.

- Community participation and ownership is seen as an important aspect, this implies that communities are ready to address the needs of disabled people.

- PARISH workers are expected to work out in the communities; they sometimes do not have the back up of infrastructure, systems or professionals to help.

- The organisation and management of Community Based R rehabilitation is complex and difficult.

BY GRACE SARIA

an occupational therapist and Nurse midwife